Skinner David Lee, Kong Victor Y, de Vasconcellos Kim, Bruce John L, Bekker Wanda, Laing Grant L, Clarke Damian L
Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
Department of Surgery, Pietermartizburg, School of Clinical Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
J Surg Res. 2018 Dec;232:376-382. doi: 10.1016/j.jss.2018.06.069. Epub 2018 Jul 19.
This study sought to describe the burden of disease of acute kidney injury (AKI) among adult South African trauma patients who presented to a tertiary level trauma service.
The trauma database was interrogated for the period from December 2012 to July 2017. All patients over the age of 18 y, who were admitted following trauma, were included. Outcome data were reviewed. This included in-hospital mortality, need for intensive care unit admission, and length of stay. AKI was defined according to the latest Kidney Disease Improving Global Outcomes guidelines using the presentation serum creatinine.
A total of 7613 patients were admitted for trauma over the period under review. Four thousand two hundred sixty-six patients were suitable for analysis. A total of 238 (5.6%) patients presented with AKI, 149 (62.6%) had stage 1 AKI, 40 (16.8%) had stage 2 AKI, and 49 (20.6%) had stage 3 AKI. There was a higher incidence of AKI in patients with blunt trauma. The length of stay, need for intensive care unit admission, and mortality were significantly higher in patients presenting with AKI than in those who did not present with AKI. There were 172 deaths (4.0%). The patients who died were older and had significantly higher Injury Severity Score than survivors. They were more acidotic on presentation, had lower Glasgow Coma Scale, and were more likely to be hypotensive on presentation. They also were significantly more likely to have AKI on presentation. (30.2% versus 5.6% P < 0.001). AKI on presentation was an independent risk factor for mortality (odds ratio 3.038 95% confidence interval 1.260-7.325).
AKI is common in patients presenting to our center with acute trauma. The presence of AKI is associated with increased morbidity and mortality. Efforts must be directed to improving recognition of at-risk patients. Prompt referral and adequate resuscitation of trauma patients before transfer must be prioritized.
本研究旨在描述在一家三级创伤中心就诊的成年南非创伤患者中急性肾损伤（AKI）的疾病负担。
查询2012年12月至2017年7月期间的创伤数据库。纳入所有18岁以上因创伤入院的患者。对结局数据进行回顾。这包括院内死亡率、入住重症监护病房的需求和住院时间。根据最新的改善全球肾脏病预后组织指南，使用入院时的血清肌酐来定义AKI。
在审查期间，共有7613例患者因创伤入院。4266例患者适合进行分析。共有238例（5.6%）患者出现AKI，149例（62.6%）为1期AKI，40例（16.8%）为2期AKI，49例（20.6%）为3期AKI。钝性创伤患者中AKI的发生率更高。出现AKI的患者的住院时间、入住重症监护病房的需求和死亡率显著高于未出现AKI的患者。共有172例死亡（4.0%）。死亡患者年龄更大，损伤严重程度评分显著高于幸存者。他们入院时酸中毒更严重，格拉斯哥昏迷量表评分更低，入院时更可能出现低血压。他们入院时出现AKI的可能性也显著更高（30.2%对5.6%，P<0.001）。入院时出现AKI是死亡的独立危险因素（比值比3.038，95%置信区间1.260 - 7.325）。
AKI在我院急性创伤患者中很常见。AKI的存在与发病率和死亡率增加相关。必须致力于提高对高危患者的识别。在转运前对创伤患者进行及时转诊和充分复苏必须作为优先事项。
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